Overcoming Trauma in Haiti: Reflections of a Seasoned Disaster Specialist

The circumstances surrounding the tragedy and ongoing relief efforts in Haiti can be immensely frustrating to people everywhere who don't understand why more isn't being done. As the founder and director of a small disaster relief agency based in the US, I have been active for more than 40 years throughout the world in various disaster scenarios. I'd like to share my observations with regard to the response in Haiti compared to other areas, particularly in as much as I have seen many similar disasters and their aftermath in the past decade. I usually go directly to areas where our team can do the most good, but this can only happen after the dire emergency like we are presently witnessing passes. Because of the horrific situation people are observing on television, on the web and in print, I thought it might be helpful to share my observations and take a bigger view of the phases Haitians will go through in the weeks ahead. This will mean that we must be prepared to support a period of recovery that follows the urgent needs we all are witnessing now.

There have been 50 more "aftershock" earthquakes in Haiti since the one that began it on January 12th. Aftershocks really get your attention on the ground when they are between 4.5 and 5.8 in magnitude, as these have all been. Haitians and responders are getting re-traumatized every day. Three phases that follow disasters of this magnitude are well known to occur. The first Emergency Phase necessitates immediate response to provide those basic needs mentioned above. Haiti is clearly in this phase now, and will be for the foreseeable future because of both the scale of the disaster and the lack of infrastructure and basic needs that existed before the earthquake struck the island. Emergency response is typically carried out by major organizations such as the International Red Cross, UNICEF, Mercy Corps, Doctors Without Borders and others to whom most people automatically donate funds; unfortunately, this often leaves other worthy organizations under financed to carry out work needed in the second and third phase when "donor fatigue" sets in. Following what will undoubtedly be an outpouring of generosity as a result of the upcoming telethon and other efforts by politicians, professional athletes and superstars, the emergency work will shift to a different phase.

What follows the Emergency Phase is a period of 8-12 weeks that comes after the initial impact of a hurricane, earthquake or typhoon, often referred to as the Recovery Phase. When an earthquake strikes, our agency begins to prepare trauma teams to help children and families on the ground. We are mental health specialists who would usually arrive in an affected area between 10 days and 2 weeks after an event, thereby allowing time for the most basic needs of food, shelter, water and hygiene to be met. In Samoa, for example, following the earthquake there in September of 2009, we were contacted and hosted by the medical school where we immediately went about the business of training a psycho-social mental health team, doctors, medical students, ministers, community leaders and others who were previously unfamiliar with dealing with trauma. We conduct a number of high-impact programs, raising capacity on the ground through a series of exercises and simple practices that help children and families recover. We provide small "manuals" that are clear and simple, and distribute them to all those who ask. They can be downloaded from our website as well.

The Recovery Phase is the most misunderstood period following a disaster. As ongoing efforts to distribute food and water receive the most attention, people begin to recover from the initial shock and terror of the event and its immediate aftermath on the ground. This is the phase in which we are most intimately involved, the time when normal adaptive responses on the part of children and families allow most of those affected to recover naturally; however, many individuals are frequently misdiagnosed as having Post Traumatic Stress Disorder, or PTSD -- a label that is not accurately applied until the third phase. Journalists are already beginning to write about trauma in Haiti and the need for mental health workers; however, beyond some hand holding and comforting the injured and dying, there is only so much "trauma work" that can be done that will make a difference now.

Imagine trying to help a soldier to overcome his trauma while bullets are still flying overhead, or counseling a victim of rape in prison who legitimately fears the night ahead. Ordinary people need to be assured of some semblance of safety in order to process the past; victims of trauma need more than the ordinary, and any seasoned trauma specialist knows this. Now may be a time to determine the few extremely disassociated individuals among the thousands who are coping normally in the aftermath, but it is not yet a time to use the PTSD label.

Our work facilitates communities to recover a sense of safety for children, relieve fear, and allow grief, anger and sadness to be expressed as most people naturally heal from trauma. When these very real emotions are not validated by a culture, they can become distorted and repressed, resulting in systemic illnesses that begin to manifest 90-120 days after an event. Such issues as skin problems, psoriasis and eczema, diarrhea or obstructive bowel disorders, respiratory symptoms like asthma and allergies as well as regressive bedwetting, clinging, flashbacks, etc. then manifest. These create an enormous, unnecessary burden on the health care system, and this is likely to occur in Haiti if those in charge do not proceed with caution, awareness and skill. Physical manifestations of trauma can be prevented in 95% of people if the psychosocial response to a disaster in the second phase is well coordinated.

The third phase is the Reconstruction Phase, something that takes time, money and cooperation; unfortunately, governments are eager to skip the second phase and start building new structures before victims are ready to stand on their own. The need to clear away massive amounts of debris and restore basic services throughout the country is an indication that Haiti will not move into the third phase for months. Most onlookers are already wondering when the huge land movers will arrive to clear the streets.

While every donor wants to feel confident that his contribution to help those in need will not go to waste, a reality check on the current situation may be helpful. Large ports in major cities like, Los Angeles, Miami, Singapore, Tokyo, New York and Sydney, etc. have extraordinary infrastructures and resources (cranes, space, staffing, etc.) that make handling containers and shipments of aid coming into a country very efficient. This is not the case in Haiti, and was not the case before the earthquake did its damage. In Samoa, where the port in Apia became log jammed with tangible signs of goodwill, some journalists wrote unfair accusatory articles about delayed shipments. The problem was not with officials, but rather with the infrastructure, and the same is likely to be the case in Port-Au-Prince. While we were in Sri Lanka following the 2004/2005 tsunami disaster that killed more than 300,000 people in Indonesia, many containers -- even those sent by major donors like Oxfam -- sat in the harbor offshore waiting to be given clearance and berths to offload supplies. Sadly for one international relief group, nearly $1 Million of donated supplies were returned because the port in Colombo, Sri Lanka was simply not big enough to handle the incoming shipments. A similar thing may occur in Haiti, but this is not the fault of the government, any politician or organization; it is the reality of priority, available space and a dire lack of existing resources and infrastructure -- as well as the outpouring of generous support by those concerned. Haiti is simply not going to be able to move as efficiently as many other cultures, but it does no good at all to blame anyone and complain about why this is the case.

It is the resiliency of the Haitian people, their faith and community support, which will rebuild their country -- not timber and nails or bricks and mortar. If the former is not given loving support from outsiders, mental health professionals, clergy and all those who care, then what we are likely to witness will be even more grim than watching tens of thousands of bodies waiting to be buried. Instead of watching as building materials are distributed, we could witness an entire country traumatized by a pervasive lack of understanding of the emotional needs of victims of a major disaster.

Though I believe that Haiti can heal and grow in the coming months, what is needed from abroad even more than money is patience and respect for the process. We must all keep in mind that recovery and reconstruction always tests people's patience. I do not have enough fingers and toes to count the number of times I have seen people go for months following a disaster without adequate housing, roads or other elements of an infrastructure that was demolished by a cyclone, earthquake, tsunami, bombing or floods; however, as sad as this may be, it is the reality of a disaster that affects a small country like Haiti. Taking care of people's emotional needs is not separate from providing extra blankets or bars of soap. Agencies who work heart-to-heart will need generous donors, too.

When a disaster strikes, my heart opens to those in need, and like many of you, I want to respond -- but I know my limits and understand the process from firsthand experience. I sincerely hope that the kindness and generous spirits of so many will continue to flourish for Haiti, making it possible for repeated visits by those who care -- not just the first responders in this emergency phase. Most small NGOs operate in much the same way, that is, they carry an ongoing concern about the people they first serve. We are aware of the reality of what takes place after a disaster like this and welcome the opportunity to work with victims of trauma when we know we can make a long lasting difference in their lives and prevent PTSD.

For those interested in our work in Sri Lanka, Java and Samoa, please visit www.fortunateblessings.org to read the journal of our activities in the section called Global Outreach. We remain eager to help when the time is right and will need the generous support of those who understand and appreciate the importance of emotional work during the Recovery Phase.